Jolliffe Laura, Lannin Natasha A, Cadilhac Dominique A, Hoffmann Tammy
Discipline of Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.
Occupational Therapy Department, Alfred Health, Prahran, Australia.
BMJ Open. 2018 Feb 28;8(2):e018791. doi: 10.1136/bmjopen-2017-018791.
Rehabilitation clinical practice guidelines (CPGs) contain recommendation statements aimed at optimising care for adults with stroke and other brain injury. The aim of this study was to determine the quality, scope and consistency of CPG recommendations for rehabilitation covering the acquired brain injury populations.
Systematic review.
Included CPGs contained recommendations for inpatient rehabilitation or community rehabilitation for adults with an acquired brain injury diagnosis (stroke, traumatic or other non-progressive acquired brain impairments). Electronic databases (n=2), guideline organisations (n=4) and websites of professional societies (n=17) were searched up to November 2017. Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations.
From 427 papers screened, 20 guidelines met the inclusion criteria. Only three guidelines were rated high (>75%) across all domains of AGREE-II; highest rated domains were 'scope and purpose' (85.1, SD 18.3) and 'clarity' (76.2%, SD 20.5). Recommendations for assessment and for motor therapies were most commonly reported, however, varied in the level of detail across guidelines.
Rehabilitation CPGs were consistent in scope, suggesting little difference in rehabilitation approaches between vascular and traumatic brain injury. There was, however, variability in included studies and methodological quality.
CRD42016026936.
康复临床实践指南（CPGs）包含旨在优化对中风及其他脑损伤成人患者护理的推荐声明。本研究旨在确定针对获得性脑损伤人群的康复CPG推荐的质量、范围和一致性。
系统评价。
纳入的CPG包含针对患有获得性脑损伤诊断（中风、创伤性或其他非进行性获得性脑损伤）的成人患者的住院康复或社区康复推荐。检索电子数据库（n = 2）、指南组织（n = 4）和专业协会网站（n = 17）直至2017年11月。两名独立评审员使用《研究与评价指南评估》（AGREE）II工具，并采用文本综合法对推荐进行评估和比较。
在筛选的427篇论文中，20篇指南符合纳入标准。在AGREE-II的所有领域中，只有3篇指南被评为高分（>75%）；评分最高的领域是“范围和目的”（85.1，标准差18.3）和“清晰度”（76.2%，标准差20.5）。评估和运动疗法的推荐最为常见，但各指南在详细程度上有所不同。
康复CPG在范围上是一致的，表明血管性脑损伤和创伤性脑损伤之间康复方法差异不大。然而，纳入研究和方法质量存在差异。
PROSPERO注册号：CRD42016026936。
